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We performed magnetic resonance spectroscopy (MRS) of 2\u2010hydroxyglutarate (2HG) and glycine in patients with brainstem tumors to assess the feasibility of detecting and quantifying 2HG in the brainstem to obviate the need for a diagnostic biopsy and to establish the clinical significance of glycine MRS in brainstem tumors in\u00a0vivo. Twenty adult patients with radiographically identified presumed brainstem gliomas were prospectively enrolled in the study. Proton MRS was obtained at 3T with a protocol tailored for detection of 2HG and glycine (TE 97\u2010ms PRESS). Spectra were fit using LCModel software and in\u2010house basis signals of metabolites and lipids. The metabolite concentrations were quantified with reference to water and examined with respect to clinical outcomes, including postgadolinium MRI and overall survival time. MRS data from 19 patients were included in subsequent analysis, excluding suboptimal data from one patient. Tumors with elevated 2HG (&gt;\u20091.9\u2009mM, <jats:italic>N<\/jats:italic>\u2009=\u20098) and undetectable\u00a02HG (&lt;\u20090.3\u2009mM, <jats:italic>N<\/jats:italic>\u2009=\u200911) were clearly distinguishable. Tumors with elevated glycine (&gt;\u20091.5\u2009mM, <jats:italic>N<\/jats:italic>\u2009=\u20094) showed rapid progression. Kaplan\u2013Meier survival analyses with metabolite measures demonstrated that tumors with 2HG higher than 1.0\u2009mM were significantly associated with a favorable prognosis (<jats:italic>p<\/jats:italic>\u2009=\u20090.01). In contrast, tumors with glycine higher than 2.5\u2009mM showed a strong association with poor survival (<jats:italic>p<\/jats:italic>\u2009=\u20090.0005). The data confirm detection of 2HG in brainstem tumors at a concentration that is consistent with an IDH mutation and expected good prognosis, whereas elevated glycine in brainstem tumors portends rapid tumor progression and a worse prognosis.<\/jats:p>","DOI":"10.1002\/nbm.70153","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T07:40:33Z","timestamp":1759218033000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Magnetic Resonance Spectroscopy of 2\u2010Hydroxyglutarate and Glycine in Adult Subjects With Brainstem Gliomas"],"prefix":"10.1002","volume":"38","author":[{"given":"Vivek","family":"Tiwari","sequence":"first","affiliation":[{"name":"Department of Biological Sciences Indian Institute of Science Education and Research  Behampur Odisha 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